Assessment of Symptom, Disability, and Financial Trajectories in Patients Hospitalized for COVID-19 at 6 Months
Authors: Andrew J. Admon, Theodore J. Iwashyna, Lee A. Kamphuis, Stephanie J. Gundel, Sarina K. Sahetya, Ithan D. Peltan, Steven Y. Chang, Jin H. Han, Kelly C. Vranas, Kirby P. Mayer, Aluko A. Hope, Sarah E. Jolley, Ellen Caldwell, Max L. Monahan, Katrina Hauschildt, Samuel M. Brown, Neil R. Aggarwal, B. Taylor Thompson, Catherine L. Hough, Francois Abi Fadel, Michael Aboodi, Samuel Acquah, Jason Y Adams, Neil Aggarwal, Narendrakumar Alappan, Timothy E Albertson, Mohammed Al-Jaghbeer, Eyad Almasri, James S Andrews, Derek C Angus, Jason V Baker, Rebecca Baron, Michael Baumann, Torben Becker, Michelle Biehl, Billie A Bixby, Joseph R Bledsoe, John W Bloom, Somnath Bose, Katherine L Boyle, Patrick Bradley, Rich D Branson, Samuel Brown, Ellen L Burnham, Carolyn Calfee, Sean J Callahan, Alessandro Cancelliere, Shannon Carson, Jonathan D Casey, Steven Y Chang, Sweta Chekuri, Peter Chen, Tina Chen, James Chenoweth, Philip Choi, Ivan Co, Sean Collins, Ana Carolina Costa Monteiro, Mick Couper, Christopher Cox, Jonathan Daich, Marjolein de Wit, Ben P deBoisblanc, Matthew R Dettmer, Sanjay Dhar, David Dillon, Sarah Doernberg, Pratik B Doshi, Ivor S Douglas, Brian Driver, Siddharth P Dugar, Abhijit Duggal, Marie-Carmelle Elie, Kyle B Enfield, John Eppensteiner, Daniel Fein, Michael Filbin, Clark Files, James H Finigan, Alexander H Flannery, Andrea Foulkes, Alpha A Fowler, Adam Frisch, Monica Fung, John Gaillard, James W Galbraith, Sheetal Gandotra, Jayna M Gardner-Gray, Elizabeth A Gay, Kevin Gibbs, Evanpaul Gill, Adit Ginde, Timothy D Girard, Pauline H Go, Neha N Goel, Ewan C Goligher, Jose Gomez-Arroyo, Michelle Ng Gong, Andrew J Goodwin, Richard D Gordon, Colin K Grissom, Kyle Gunnerson, Jin Ho Han, Tarik Hanane, Christopher K Hansen, Kyle Happel, Estelle S Harris, Jason Haukoos, Gregory W Hendey, Carolyn M Hendrickson, Kathryn A Hibbert, Ellie Hirshberg, R. Duncan Hite, Aluko A Hope, Jason Hoth, Peter C Hou, Terri Hough, Judie A Howrylak, David T Huang, Kristin Hudock, Ryan Huebinger, Gina Hurst, Cameron D Hypes, Robert C Hyzy, Nicole Iovine, Marjan Islam, Jennifer Israel, Jack Iwashyna, Faraz Jaffer, William Janssen, Namita Jayaprakash, Shijing Jia, Nicholas J Johnson, Sarah Jolley, Alan Jones, Elizabeth Jones B Jones, Alex Kadl, Kirsten N Kangelaris, Markos G Kashiouris, Lawrence E Kass, Marla Keller, Akram Khan, Mehdi Khosravi, Hassan Khouli, Harish Kinni, Michael E Kiyatkin, Daniel Knox, Amita Krishnan, Nicholas Kurtzman, Matthew R Lammi, Michael J Lanspa, Viet Le, Lindsay M Leither, Joseph Levitt, Michael L'Heureux, George Lim, Alexander Limkakeng, Michael Y Lin, Christopher Lindsell, Kathleen Liu, Kenneth Lyn-Kew, Patrick G Lyons, Fraser C Mackay, Patrick J Maher, Simon A Mahler, Anita Malhotra, Brian E Malley, Michael A Matthay, Teresa May, Katherine Mayer, Kirby P Mayer, Jakob I McSparron, Bryan J McVerry, Chadwick D Miller, Stephen Miller, Steven C Minear, Eduardo Mireles, Jason Mock, Amira Mohamed, Ashley A Montgomery-Yates, Peter Morris, Jarrod M Mosier, Ari Moskowitz, Marc Moss, Simon R Mucha, Elizabeth Munroe, Rahul Nair, Utsav Nandi, Denise Nassisi, William Nkemdirim, Dustin L Norton, Brian O'Gara, Daniel J O'Hearn, Darragh Shane OMahony, David B Page, Robert Paine, Pauline K Park, Sara Pasha, Gabriel D Patarroyo Aponte, Avignat Patel, Bela Patel, Ithan D Peltan, Sarah Perman, Jacqueline Marie Pflaum-Carlson, Simone Phang-Lyn, Victor Pinto-Plata, Matthew E Prekker, Mike Puskarich, Nida Qadir, Raju M Reddy, Todd W Rice, Lynne D Richardson, Richard R Riker, Emanuel P Rivers, Bryce RH Robinson, Angela J Rogers, Derek W Russell, Debasis Sahoo, Christian Sandrock, Shane Sanne, Rachel G Scheraga, Eric Schmidt, Jordan B Schooler, Kristin Schwab, Wesley H Self, Matthew W Semler, Paulina Sergot, Faraaz Shah, Nate Shapiro, Daniel L Shaw, Robert Sherwin, Matthew Siuba, Michael Sjoding, Howard Smithline, Mark R Sochor, John R Spurzem, Vasisht Srinivasan, Tessa L Steel, Jay S Steingrub, Bryan Stenson, Sarah A Sterling, Jason Stopyra, William-May B Stubblefield, Jeffrey M Sturek, Jamie L Sturgill, Jennifer Swiderek, Aamer Syed, Daniel Talmor, Geneva Tatem, Nirosshan Thiruchelvam, Taylor Thompson, Melissa L Thompson Bastin, Mark Tidswell, Sam S Torbati, Stacy A Trent, Terren Trott, Thomas E Van der Kloot, Kelly C Vranas, Bonnie Wang, Ralph Wang, Lorraine Ware, Christopher M Waters, Alexandra J Weissman, Katherine D Wick, Aimee M Wilkin, David M Wilson, Jenny G Wilson, David L Wyles, Joseph H Yanta, Donald M Yealy, Scott Youngquist, Tanzira Zaman
Journal: JAMA Network Open (2023)

Importance Individuals who survived COVID-19 often report persistent symptoms, disabilities, and financial consequences. However, national longitudinal estimates of symptom burden remain limited. Objective To measure the incidence and changes over time in symptoms, disability, and financial status after COVID-19–related hospitalization. Design, Setting, and Participants A national US multicenter prospective cohort study with 1-, 3-, and 6-month postdischarge visits was conducted at 44 sites participating in the National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Network's Biology and Longitudinal Epidemiology: COVID-19 Observational (BLUE CORAL) study. Participants included hospitalized English- or Spanish-speaking adults without severe prehospitalization disabilities or cognitive impairment. Participants were enrolled between August 24, 2020, and July 20, 2021, with follow-up occurring through March 30, 2022. Exposure Hospitalization for COVID-19 as identified with a positive SARS-CoV-2 molecular test. Main Outcomes and Measures New or worsened cardiopulmonary symptoms, financial problems, functional impairments, perceived return to baseline health, and quality of life. Logistic regression was used to identify factors associated with new cardiopulmonary symptoms or financial problems at 6 months. Results A total of 825 adults (444 [54.0%] were male, and 379 [46.0%] were female) met eligibility criteria and completed at least 1 follow-up survey. Median age was 56 (IQR, 43-66) years; 253 (30.7%) participants were Hispanic, 145 (17.6%) were non-Hispanic Black, and 360 (43.6%) were non-Hispanic White. Symptoms, disabilities, and financial problems remained highly prevalent among hospitalization survivors at month 6. Rates increased between months 1 and 6 for cardiopulmonary symptoms (from 67.3% to 75.4%; P = .001) and fatigue (from 40.7% to 50.8%; P &amp;amp;lt; .001). Decreases were noted over the same interval for prevalent financial problems (from 66.1% to 56.4%; P &amp;amp;lt; .001) and functional limitations (from 55.3% to 47.3%; P = .004). Participants not reporting problems at month 1 often reported new symptoms (60.0%), financial problems (23.7%), disabilities (23.8%), or fatigue (41.4%) at month 6. Conclusions and Relevance The findings of this cohort study of people discharged after COVID-19 hospitalization suggest that recovery in symptoms, functional status, and fatigue was limited at 6 months, and some participants reported new problems 6 months after hospital discharge.